We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Radiological Case of the Month FREE

Tom N. Hilliard, MRCP; Michael J. Marsh, MRCP; Paul Malcolm, FRCR; Ian A. Murdoch, MRCP; Beverly P. Wood, MD
[+] Author Affiliations

Section Editor: Beverly P. Wood, MD

Arch Pediatr Adolesc Med. 1998;152(11):1147-1148. doi:10.1001/archpedi.152.11.1147.
Text Size: A A A
Published online

A 7-DAY-OLD boy presented with a 1-day history of poor breast-feeding. He was alert, with cold extremities, reduced skin turgor (Figure 1), dry mucous membranes, and a sunken anterior fontanelle. His weight was 2.66 kg, representing a loss of 25% from birth. The plasma sodium level was 174 mmol/L; urea nitrogen, 40 mmol/L (112 mg/dL); creatinine 111 µmol/L (1.25 mg/dL); leukocyte count, 12.3 ×109/L; and fibrinogen, 0.98 g/L (reference range, 1.5-4.5 g/L).

A blood culture was performed prior to administration of intravenous broad spectrum antibiotics. He was treated with intravenous fluids containing 40-mmol/L sodium, at 275 mL/kg per day. Ten hours after admission, his plasma sodium level had fallen to 156 mmol/L and 4 hours later the neonate had 2 brief generalized seizures. Rectal diazepam, intravenous mannitol, and phenytoin were given. He became apneic and required tracheal intubation, mechanical ventilation, and was transferred to the pediatric intensive care unit.

Renal diagnostic ultrasound showed no abnormalities. A cranial sonogram showed effacement of the subarachnoid spaces indicating moderate cerebral edema. An unenhanced computed tomogram (CT) of the brain also demonstrated cerebral edema, and high density and enlargement of the superior sagittal sinus with sparing of the anterior portion (Figure 2). A diagnosis of acute sagittal sinus thrombosis was made. A subsequent color Doppler sonogram also demonstrated absence of flow in the superior sagittal sinus, except in the anterior portion. The sagittal sinus with color flow signal in adjacent cortical arteries is shown (Figure 3).

Intravenous fluids with 140-mmol/L sodium were given during a 72-hour period to correct dehydration. He was treated with ventilatory support and intravenous antibiotics for 2 days. One day after admission, the urinary sodium level was 50 mmol/L and urinary osmolality was 723 mmol/kg. His mother expressed very small volumes of breast milk, with a sodium content of 16 mmol/L. The plasma sodium approached more normal levels during the next 4 days, as progressively more hypotonic fluids and enteral feedings were given.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

12 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Clarifying Your Question

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Three Examples of Question Clarification